腹腔镜下闭孔神经子宫内膜异位症切除术：渐进式方法

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.092

S. Alani , D. Bach Nguyen , F.W. Mansour , J. Papillon-Smith , S. Krishnamurthy , A. Zakhari

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引用次数: 0

摘要

研究目的探讨腹腔镜下累及闭孔神经的子宫内膜异位症切除术的可行性。设计解说手术视频。学术三级医院。患者或参与者一例30岁女性，MRI发现1.6厘米子宫内膜异位症结节累及左闭孔神经，同时伴有bbb、直肠阴道和输尿管子宫内膜异位症。由于症状难以治疗，除了行直肠椎间盘切除和输尿管再植外，还行腹腔镜切除闭孔神经病变。介入术：腹腔镜手术治疗闭孔神经子宫内膜异位症。手术步骤可归纳为六个步骤：(1)腹部检查；(2)乙状结肠活动；(3)髂腰间隙（外侧）剥离；(4)直肠旁间隙（内侧）夹层；(5)闭孔间隙（尾侧）剥离；(6)结节释放和切除。结论在充分了解解剖知识和系统解剖盆腔间隙的基础上，腹腔镜下手术切除闭孔神经子宫内膜异位症是安全可行的。MRI对这些罕见的深浸润性子宫内膜异位症的术前规划至关重要。

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查看原文本刊更多论文

Laparoscopic Excision of Obturator Nerve Endometriosis: A Stepwise Approach

Study Objective

To demonstrate a reproducible approach to the laparoscopic excision of endometriosis involving the obturator nerve.

Design

Narrated surgical video.

Setting

Academic tertiary care hospital.

Patients or Participants

Case of a 30-year-old woman found on MRI to have a 1.6 cm endometriosis nodule involving the left obturator nerve, along with adenomyosis, rectovaginal and ureteric endometriosis. Due to symptoms refractory to medical management, a laparoscopy is performed to excise the obturator nerve lesion, in addition to a disc rectal excision and ureteral reimplantation.

Interventions

Laparoscopic excision of obturator nerve endometriosis.

Measurements and Primary Results

The surgical steps can be summarized in six steps: (1) abdominal survey; (2) sigmoid mobilization; (3) iliolumbar space (lateral) dissection; (4) pararectal space (medial) dissection; (5) obturator space (caudal) dissection; (6) nodule release and excision.

Conclusion

Excision of obturator nerve endometriosis by laparoscopy can be safely performed with a thorough knowledge of anatomy and a systematic dissection of pelvic spaces. MRI is essential for preoperative planning in these rare forms of deep infiltrating endometriosis.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.